Health Ministry to study if Integrated Shield Plan insurance can be made 'fully portable'

SINGAPORE — The Ministry of Health (MOH) will study whether Integrated Shield Plans can be made fully portable, but this could result in higher premiums, said Senior Minister of State for Health Koh Poh Koon in Parliament on Monday (May 10).

The ministry will look at examples from abroad, he added.

Integrated Shield Plans offer private insurance coverage on top of MediShield Life, Singapore's national health insurance scheme.

People may also purchase riders that typically cover the deductible and co-payment portion of the medical bill.

"MOH recognises that some policyholders may wish to switch insurers, whether for more competitive premiums or for better benefits such as access to more panel doctors, but are unable to do so because of pre-existing conditions," said Dr Koh.

“However, insurers may potentially need to increase the premiums significantly for all policyholders to price in the increased risk they assume for portable IP that covers pre-existing conditions."

Dr Koh was responding to a range of questions about Integrated Shield Plans, including the number of people who have given up Integrated Shield Plan, the rate of premium increases and the issue of insurers' panel doctors.

This follows the recent debate between insurers and medical professionals, largely over the number of private specialists on insurers' panels and their selection criteria.

CO-PAYMENTS

Currently, about 70 per cent of Singapore residents have Integrated Shield Plans, said Dr Koh. Less than half have purchased riders.

Dr Koh noted that MOH introduced a minimum five per cent co-payment for all new private riders in 2018, after recommendations by the Health Insurance Task Force.

In April this year, insurers extended the co-payment requirement to existing policyholders with riders.

To assure policyholders concerned with potentially large co-payments, MOH allowed insurers to apply a S$3,000 co-payment cap for treatment from panel doctors with negotiated fee arrangements with insurers.

This means that co-payment for bills above S$60,000 is capped at S$3,000.

"To put things in perspective, less than 3 per cent of inpatient bills in private hospitals today exceed S$60,000. So the vast majority of inpatients bills do not hit the cap," Dr Koh said.

Should the ministry allow the co-payment cap to apply to all treatments, policyholders may, for example, choose a S$100,000 treatment over an equally effectively S$70,000 treatment, he said, as they would only need to pay S$3,000 for either option.

Thus, it would "negate" the effect of co-payment once the cap is reached, he said.

In such cases, the additional costs would be borne by the insurer, eventually translating to higher premiums for other policyholders.

"Therefore, the cap was applied to panelled doctors, where there are established fee arrangements to ensure that appropriate and cost-effective treatment is provided," he said.

Over the last five years, about five per cent of policyholders relinquished their Integrated Shield Plans per year on average, said Dr Koh.

Their average age was 34.

This could be due to policyholders opting for different coverage after considering the cost of premiums, their financial resources and healthcare needs.

IP PANELS

Dh Koh acknowledged that questions have been raised about whether limited panel sizes are in the best interest of the patients, whether such practices are anti-competitive and if there are medical ethical concerns around such practices.

"These practices do not contravene the Competition Act as any decision to empanel doctors is made by individual insurers independently with doctors, on mutually acceptable terms," he said.

"Such practices do not restrict insurers from competing with one another on their prices, insurance products, or choice of doctors."

Nevertheless, Dr Koh said MOH has encouraged insurers to make their panel selection criteria more transparent.

On medical ethics, Dr Koh said access to care and doctors' clinical judgment "should not be influenced by empanelment ... financial constraints or pressures inherent in any health system".

He stressed that all patients can make claims for all treatments covered under their Integrated Shield Plans, regardless of whether the specialist is on a panel.

He added that some insurers have grown the size of their panels. Currently, more than 70 per cent of private specialists are on at least one IP panel.

To suggestions for all doctors to be on a panel, Dr Koh said that some may choose not to as they already have enough patients.

"Hence, MOH encourages IP insurers to enhance their pre-authorisation processes, to give approval for hospitalisation or treatments and their associated costs beforehand," he added.

A government-appointed committee, set up in April, will look into refining various feature of Integrated Shield Plans.

On Monday, Dr Koh said that the Multilateral Healthcare Insurance Committee will prioritise four workstreams.

These include panels and pre-authorisation, improving transparency across the board, establishing a claims complaints process and examining issues from a patient and consumer-centric viewpoint.

RANKING INSURERS

In a supplementary question, MP Lim Wee Kiak (PAP-Sembawang) asked if MOH would consider ranking insurers.

In response, Dr Koh said it is "hard to say" how to rank insurers, as they may have product differentiation meeting different people's needs.

"I think it's very hard for MOH to decide from one person to the next, which is the best product to suit the person's needs. What we should do is put up more information so that patients and policyholders can make the right informed choices," he said. CNA

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